Venoarterial Bypass in Hypothermia

Abstract

To the Editor.— Referring to the article Recovery After Prolonged Asystolic Cardiac Arrest in Profound Hypothermia: A Case Report and Literature Review by Southwick and Dalglish (1980;243:1250), their discussion of treatment did not include cardiopulmonary bypass as an aid in resuscitation and rewarming. Cardiopulmonary bypass has been advocated for core rewarming after accidental profound hypothermia. 1,2 I recently resuscitated a 60-year-old man who was asystolic for 120 minutes because of profound accidental hypothermia (initial rectal temperature 26 °C). After 90 minutes of external cardiac compression and attempts to rewarm using warm blankets, water-heated mattresses, intravenous infusions of warm saline solution, and gastric and bladder lavages, the patient was given a venoarterial bypass using the right femoral artery and vein. Partial cardiopulmonary bypass with flow rates of 800 to 1,000 mL/min was used to gradually rewarm and help maintain the circulation during the remainder of the asystolic period. Venoarterial bypass at